Subacute scaphoid fractures. A closer look at closed treatment.
Twenty-three subacute scaphoid fractures were retrospectively reviewed to determine the efficacy of nonoperative treatment. All of the patients sought medical attention between 4 weeks and 6 months after injury, and their fractures were classified according to location and stability. Nineteen fractures were observed to radiographic union or until closed treatment was abandoned; four patients were lost to followup. Nine of 10 stable subacute middle-third scaphoid fractures healed with cast immobilization in an average of 19 weeks (range, 11 to 38), and these were compared with a randomly selected group of acute middle-third fractures that healed in an average of 10 weeks (range, 6 to 13). Five of six unstable subacute middle-third fractures healed in an average of 20 weeks. One of these had a symptomatic humpback deformity treated by cheilectomy. Of three subacute proximal-third fractures, only one healed after 29 weeks of closed treatment. This study demonstrates that stable subacute middle-third scaphoid fractures will heal with cast treatment but may take twice as long to do so as stable acute middle-third fractures. Unstable subacute middle-third scaphoid fractures and subacute proximal-third fractures appear less likely to heal with closed treatment.
Mack
G R
GR
Department of Orthopaedic Surgery, Naval Medical Center, San Diego, California 92134-5000, USA.
Wilckens
J H
JH
McPherson
S A
SA
D000293:Adolescent; D000328:Adult; D002348:Carpal Bones / Q000293:injuries*; D002370:Casts, Surgical; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome